Provider Demographics
NPI:1518184035
Name:JENNINGS, GEORGE RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RUSSELL
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 AVALON AVE
Mailing Address - Street 2:300
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2869
Mailing Address - Country:US
Mailing Address - Phone:256-386-1450
Mailing Address - Fax:256-386-1463
Practice Address - Street 1:203 AVALON AVE
Practice Address - Street 2:300
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2869
Practice Address - Country:US
Practice Address - Phone:256-386-1450
Practice Address - Fax:256-386-1463
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL306402086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL148463Medicaid
AL148463Medicaid